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3D cad-cam orthotic systems..

Discussion in 'Biomechanics, Sports and Foot orthoses' started by cpoc103, Jul 28, 2009.

  1. cpoc103

    cpoc103 Well-Known Member


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    Hi all, just have a quick query/ would like to get views on 3D cad-cam orthotic systems, specifically the Orthema system with Mill.
    I have never used a cad-cam system, and other systems I have seen dont leave much to be desired. I would like to gain as much info before I embark to use this system, and tinternet is not giving me a lot of info.

    cheers
    Col. :drinks
     
  2. Craig Payne

    Craig Payne Moderator

    The Orthema system is a copy of the Amfit system, now that Amfits patent expired.

    They good systems.

    It all comes down to the question I keep asking participants at the Boot Camps (sorry to keep pushing that barrow)... can you get the segments of the foot into the position you need during the negative model production to deliver the prescription variables that your clinical testing showed are needed? and Can the production method deliver the design parameters needed to deliver the prescription variables needed during shell production?
     
  3. CraigT

    CraigT Well-Known Member

    We have an Amfit system...
    You can position the foot quite well, and because it uses an airbag to push the pins up, you can get close to a non weight-bearing scan. Close, but not the same...
    We get good results by milling out a positive (foam blanks supplied by amfit), doing final modifications to the model by hand, then vacumm forming with poly or carbon. Not sure if the orthema allows milling of a positive.
    Unfortunately amfit seem to have sat on their laurels, so to speak, and haven't seemed to do a lot of development- if they could to direct milling of polypropylene, it would be great, and the modifications of the scan you can make are pretty basic.
     
  4. cpoc103

    cpoc103 Well-Known Member

    Cheers Guys, Craig P, this is also my worry, as the orthema system comes with a mill, however Im pretty sure it can only mill EVA type devices, and Im worried as per your comment above. Hmmm will have to wait and see, cheers

    Col.
     
  5. cpoc103

    cpoc103 Well-Known Member

    By CP

    speaking of Boot camps Craig, I am moving to Sydney next week and was wondering if you had any camps running that way, or how I would go about finding out. Cheers

    Col.:drinks
     
  6. Craig Payne

    Craig Payne Moderator

    I am pretty sure that the Amfit one can mill wood blocks, so you can heat mold plastic to it, so assume the orthema can
    There is one in sydney 22 & 23 August. I do go over both the orthema and amfit systems.
     
  7. CraigT

    CraigT Well-Known Member

    We mill foam blocks- I doubt that the amfit mill would mill wood... erm...how much wood would a mill mill if a mill could mill wood?:wacko:
    The mill is not that heavy duty- I would like amfit to produce something which could do it- and therefore also be able to mill poly directly...
     
  8. Phil Wells

    Phil Wells Well-Known Member

    Col

    A couple of questions re purchasing a CAD/CAM system.
    Why - is it becuase you want more control of the deisgn of your FFO's, do you want to make them cheaper than out sourcing or do you need them quicker than your lab can manage?

    If it is more control over the design you want, spend all your money on a good design package and out source the milling.
    If it is cheaper, then Amfit etc are excellent.
    If it speed, then see point 2.

    It seems that if you want the total package i.e. good design capabilities and the ability to mill all types of materials, then it will cost a lot - £50 K plus and you get all the headaches with infrastructure and Health and safety.

    Hope this helps.

    Phil (Orthotic lab manager)
     
  9. cpoc103

    cpoc103 Well-Known Member

    Cheers for all the comments.
    Cheers Craig for the dates, as I am only arriving in Sydney on the 10th August the 22nd date may well be too close to my start date for work, but I have been looking at your november date in Melbourne, which I think my new company director is looking at attending, so may have to see if I can get in on this one.

    Cheers Phil for the comments, the only reason I was asking is I am migrating to Australia next week, and the company I am going to work for has just purchased an orthema system/ or is in the process of purchasing and as far as I am aware it is costing a lot of money, and I was trying to find out as much as I could as I have never used this type of equipment and was wondering if it does exactly what it says on the tin. Now I have seen the amfit and the orthotics it gives off and I have to admit I was not that impressed by them, I am happy to continue casting...but obviously I will have to work for a new company and not the NHS..

    Col.
     
  10. Arjen

    Arjen Active Member

    Hi Craig,

    My name is Arjen Sundman. I am the President of Amfit, Inc. (USA). I was hoping to clear up some of the information in this thread.
    Orthema / Amfit. Orthema's principal; Marcel Herzog (Switzerland), signed a manufacturing license to produce Amfit equipment in Europe way back in (approx) 1990. The name of his company at the time was Sportfeet AG. He did produce a number of machines before running into financial difficulty. While initially he did comply with the terms of the license, that stopped when his business faltered.
    Amfit sued for non-performance. We won in court in the US and Switzerland against Sportfeet AG. Mr. Herzog folded Sportfeet and re-incorporated a couple times in a shell game to avoid the court settlement. Right or wrong, while retaining all our rights, we have stopped actively pursuing him.

    Mr. Herzog's business has clearly used propriety Amfit know-how in designing the Orthema product line. My opinion of his business ethics is not high.

    Contrary to the OP's statement, the Orthema product's timing has nothing at all to do with any patent expiration. The Orthema product does not use a diaphragm to elevate the gauge pins under the plantar aspect of the foot. It uses an array of springs. It also has no facility to lock the sensor pins. It does not allow for mechanical adjustments like the Amfit system. It does however contact the foot like Amfit and does produce an accurate dataset within the limitations of its design. That design appears to be driven by an effort to avoid Amfit's body of patents.

    -Arjen
     
  11. Craig Payne

    Craig Payne Moderator

    Arjen, thanks for stopping by (I assume Gordon alerted you to this!). The story doing the rounds is that Orthema came about due to Amfit's patent expiry. I not sure where I heard that, but have heard it a few times. I did have a look at the Orthema system and chat to the Australia people earlier this year, which may be where I head it.
     
  12. Arjen

    Arjen Active Member

    Hi Craig,

    The Amfit contact digitizer when used in a semi-weighted position will produce a "soft-tissue deflected" contour which supports soft tissue more than hard tissue areas. It does this by using the pins to push into the plantar aspect. They push further into soft tissue than in hard (osseous) regions. This non-linearity is intentional. To get a scan of a non-weight bearing plaster cast, you'd have to make a positive plaster model and use the digitizer to measure that model. We have found patient acceptance to be better with the semi-weighted technique on the Contact Digitizer.


    Elsewhere in this thread somone is talking about milling wood on an Amfit mill. We have not tried that. I expect the mill and the grinding head would not be happy about that. The positive blocks we supply are easily milled and easily modified.

    This statement almost lit my hair on fire, but then I realized that to our foreign markets it may appear that we have been slow to introduce new product offerings. This is largely due to some disconnect between what we offer our domestic markets (through central fab) and what we sell through our distributors abroad. We have long offered TL-2100 carbon fiber F/O's for our domestic markets. We also offer polypro F/O's domestically.

    Although we have often considered adding polypro capability to the Amfit milling machine, we have (up to now) rejected it. There are few reasons for that position:

    1. Safety. You must change the milling head to cut polypro. This means exposing the user to the milling motor. We have not wanted to do that and instead make the design inherently safe.

    2. Milling a polypro is very time consuming. You must mill each shell on both sides and with two different milling tools. You need a contouring cut on the top and bottom of the shell and a change of cutting tool for the cutout of the final device. This is a significant hassle for the end user.

    3. The foreign markets have up to now not made it known to Amfit that it is a seriously demanded feature.

    Since we already offer polypros in the USA, it is obviously a fairly straight forward process to add the capability to Amfit's milling system.


    -Arjen Sundman, President, Amfit Inc.
     
  13. Arjen

    Arjen Active Member

    Hi Again Craig,

    Yes Gordon did alert me to this thread. If that heads up came from you...thank you. No worries about the info in your posting.

    It may also interest readers of this forum that Australia and New Zealand customers can (effective August 1) order products / supplies and tech support directly from Amfit USA. :drinks

    -Arjen
     
  14. Lawrence Bevan

    Lawrence Bevan Well-Known Member

    Arjen

    If Amfit could be set-up to easily mill poly devices then you'll have one helluva product on your hands.

    In all my discussions about Amfit its chief appeal is the idea of onsite manufacture, the chief downside is that the only material choices are shank-dependent. In-office cad-cam is one way of solving the many of the arguments about : "custom vs prefab", "make your own vs use a lab", "labs add to much medial addition so lets make a MASS orthotic!!". But you'll never get it to fully penetrate the market until it can make shank-independent orthotics - in-office.

    IMHO, that is.
     
  15. CraigT

    CraigT Well-Known Member

    Hi Arjen
    I am aware of what we can do with the amfit and what you can offer- we use the system to mill positives and vacuum form poly and carbon devices on site as you do back at your central production facility. It is quite effective, but we have to still make changes to the models to get something close to what we actually want.

    The scanner is very user frindly and I think gives you all the info you want for the majority of patients. HOwever the modification software is very limited with respect to the changes that you can make to the scan- I would be very pleased if Amfit was looking to try and improve this.

    What would also be great would be if we could direct mill polypropylene, and you could mill deeper models (they are often too shallow). There are CNC mills that could do this which are competitively priced, but the Amfit is a closed system. If this was opened up, or another mill was available, then it would be brilliant.
     
  16. Arjen

    Arjen Active Member

    Hi Craig,

    Thank you for your comments.

    Could you highlight examples of things you have to adjust/change?

    What would you like to do that you presently cannot? We are at a place in Amfit's software development where we are trying to lay the groundwork for the next 5 years. It is an ideal time to solicit and incorporate new software features.

    We do CNC direct milled polypro at Amfit's central fab. We are considering offering that out of house. That decision has not been made. We have to have a good feel that we can recoup the software development required for a product that is released to the public.

    Best regards,
     
  17. CraigT

    CraigT Well-Known Member

    Hi Arjen
    I will send you an email about this.
    I hope that you get input from a wide range of practitioners when it comes to further development of your system- I guess the question how much developement you do will be an economic one which I can understand.
    I will say that having spoken to my colleagues in Australia, having direct support from the US will be very much appreciated.
    Cheers
     
  18. CraigT

    CraigT Well-Known Member

    The holy grail-
    Full control of making it yourself on site, with the efficiency and repeatability of CADCAM.
    Now who will be the first to be able to offer it...
     
  19. Orthema Australasia

    Orthema Australasia New Member

    Hi all, it’s Greg Dower and Darren Stewart here. We feel this conversation could use another perspective, from both end-users of Amfit for over 15 years and now as very satisfied converts and the Australasian Distributors of Orthema CAD CAM Systems. Overall Amfit had a very suitable product, but in Australia there were a number of service and reliability issues that severely let it down. Just ask any Amfit end-user for yourself.

    Orthema’s stainless steel measurement pins are each independently raised by precision coiled springs, each rising with even and INDEPENDENT pressure. This is why Orthema pins can conform more accurately to the contour of the each individual foot, producing a more accurate dataset and therefore a more precise orthotic. A diaphragm/bladder does not raise pressure evenly, especially as it ages and stretches in the middle, and furthermore the effect of one pin depressing (say at the edge of the heel) causes a relay effect on the surrounding pins preventing them from rising independently. Just imagine sitting on a waterbed. The person next to you will move as well. The resulting effect is a very rounded (or averaged) contour to the back ½ of the orthosis, and less accurate customization than the Orthema system which uses independent pins which are indeed locked into place by a strong electromagnet. The Amfit system again uses pneumatic locking bladders which fail after some time and let the pins slide down.

    This is completely false. Orthema not only provides the basic ‘cookie cutter’ adjustments like Amfit, but also an endless array of highly prescriptive adjustments that can be moved, modified and created to suit the individuals symptomology or clinicians biomechanical preferences. Once confident with the Orthowin software, highly detailed prescriptions in the same format as modifying a plaster positive can be competed in less than 30 seconds. These include supination or pronation wedges, apertures, first ray cut-outs, 9 different types of premetatarsal domes/bars, torsion, skives and proprioception wedges of every shape imaginable. You can even design your own modifications with the shapemaker software.

    Craig, We would echo your remarks. Orthema’s “next generation” software and Swiss made machinery in general has evolved greatly in the past 10 years, and Orthema is the number 1 CAD CAM system in Europe (no small feat – excuse the pun). Industrial quality, 3-phase milling machines capable of cutting a pair at once along with integrated dust extraction keeps the workplace clean and safe. Orthoses can be precision milled in less than 15 minutes from over 15 styles of milling blocks including single, dual and tridensity, latex and cork-EVA composite styles.

    As Arjen notes, milling Poly requires a 4 or 5 axis milling machine and is not currently possible with either Amfit or Orthema milling machines. With Orthema’s denser EVA combinations, we have now ceased all poly orths with improved clinical outcomes. If you are a true polypropylene fan, one can mill a positive cast of the foot, with or without modifications, and simply vacuum form the plastic over this.
     
  20. Bruce Williams

    Bruce Williams Well-Known Member


    Craig;

    AMFIT does not do wood blocks for positives, but a sort of sand/foam. They are relatively cheap, about $5 US for a pair I think.

    They work well for pulling poly devices.

    I am able to get tremendous positioning with my AMFIT digitizer. It all comes down to understanding what you want and positioning xperience.

    Bruce
     
  21. Bruce Williams

    Bruce Williams Well-Known Member

    Craig T and Arjen;

    great discussion. If this ends up going private, please cc me! I would like to see where you guys may be going and may have some comments to add as well.

    Good to see you this week in Toronto at the APMA National Arjen. Sorry we did not have more time to chat due to my very hectic schedule.

    Bruce
     
  22. Arjen

    Arjen Active Member

    Bruce,

    It was nice to see you too...however brief.

    I am open to all input on future software ideas. Please chime in.

    -Arjen
     
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